A total of 147 patients with reduced inter-radicular bone or thin alveolar crest and who received 247 implants in the posterior region of the jaws were included in this analysis – the median follow-up time was 5 years. The survival rate for narrow diameter implants after 11 years was 95.1%. Mean marginal bone resorption was 1.16 mm, 1.53 mm and 1.74 mm after 1, 5 and 10 years, respectively. ‘Type of implant’ was identified as a strong protective risk factor against implant failure, while ‘type of rehabilitation’ was identified as a strong risk factor for implant failure. The use of narrow diameter implants in the posterior jaw is therefore viable.

The study included 31 patients with a bony deficiency of ≥ 3 mm horizontally and ≤ 3 mm vertically. A total of 46 cancellous freeze-dried block allografts were used for augmentation, and 63 implants were placed after a healing period of 6 months. The mean follow-up time was 34 ± 16 months and the mean bone gain was 5 ± 0.5 mm and 2 ± 0.5 mm horizontally and vertically, respectively. No significant differences in buccal bone resorption or mean bone thickness buccal to the implant neck were observed between implant placement and second-stage surgery. The implant and block survival rates were 98% and 95.6%, respectively.

Implant therapy was performed in 50 volunteers who first answered a questionnaire regarding influencing variables. The patient’s expectations were verified on a visual analog scale, which was used to rate the post-treatment completion. Mean aesthetic and functional ratings were 5.0 ± 2.6 and 5.0 ± 3.0, respectively, and the post-treatment ratings were 9.1 ± 1.1 and 9.0 ± 1.7, respectively; expectations were significantly exceeded. There were positive correlations between expectations and post-treatment completion ratings for both aesthetics and function and an inverse correlation between age and functional expectations.

Augmentation was performed in 93 patients using autograft, autograft plus membrane, or Bio-Oss plus membrane. Implant placement was subsequently performed and metal-ceramic crowns were placed. The 5-year implant survival rate was 96.7%, and the need for aftercare was similar in all three augmentation groups. All patients required routine inspections, 63% required oral hygiene support and 16% required additional prosthetic care. Implant placement in the maxillary anterior following augmentation appeared to be a safe and reliable treatment option.

Five or six implants were placed in the edentulous maxilla of each of 36 patients to support a 10/12 unit FDP. Cresco components were used in the first two groups, with loading after 10 days (group 1) or 6-8 weeks, (group 2) while conventional components were used in group 3, with loading after 6-8 weeks. Data were available from 30 patients after 3 years, and the adjusted mean change from baseline in crestal bone was significant in all groups (-0.65 mm, -0.5 mm and -0.4 mm in the groups 1, 2 and 3, respectively). An additional mean change of -0.29 mm was expected for each 1 mm the implant was placed deeper. No significant differences were observed between the Cresco and control groups, or between the two Cresco groups. Vertical placement therefore had more effect on bone loss than the fabrication technique.

In 17 edentulous patients, a total of 106 implants were placed, with screw-retained bridges placed after 6 months. Clinical and radiographic examinations were performed at 6 months and every year. There was one implant failure, giving an 8-year implant survival rate of 99% and prosthetic survival rate of 100%. Mean crestal bone loss was 0.3 ± 0.72 mm. High levels of patient satisfaction were found, and no higher incidence of periodontal pathogens was noted in all cases except one after 5 years. The treatment technique was therefore predictable and successful.

Bilateral sinus floor augmentation with large or small bovine bone mineral particles was performed in 10 patients, with bone samples analyzed after 6 to 9 months. Vertical bone height, post-operative complications and maximal torque were not significantly different between the three groups, but new bone volume was non-significantly greater in the small particle group. The pattern of bone formation was the same in both groups. Both sizes of particles therefore showed a similar performance and achieved the goal of the procedure.

This is an ad interim report of 15 patients from a study with a planned follow-up of 5 years. Patients were edentulous in the premolar/molar areas and received Straumann BoneCeramic and implants in a two-stage technique. The mean follow-up time for this analysis was 14.9 months. The cumulative implant survival rate was 92.5% (three implants failed in a single patient after 6 months). Sinus floor elevation with Straumann BoneCeramic may therefore be a viable clinical option.

A retrospective study was performed to evaluate patients who received sinus augmentation with bovine bone mineral or autogenous bone and with simultaneous or delayed implant placement. Marginal bone levels and statistical evaluations were performed in a subgroup of patients. A total of 282 implants were placed, with survival rates of 95.6% in autogenous bone and 100% in bovine bone mineral. In the subgroup, 39 patients received 154 implants. Significant differences in apical and marginal bone levels were observed after 1 year but not after 2 years. Significant differences were observed in the bovine bone mineral group between 1 and 2 years. Physiological bone remodelling was therefore slower but more prolonged with bovine bone mineral.

A total of 20 patients received dental implants after ablative surgery and radio-chemotherapy for oral cancer; 50 SLA and 52 SLActive implants were placed in a split-mouth design with unloaded healing of 6 weeks in the mandible (23 SLA, 24 SLActive) and 10 weeks in the maxilla (27 SLA, 28 SLActive). Mean mesial and distal bone loss was 0.4 mm and 0.4 mm, respectively, for SLA implants and 0.3 mm and 0.3 mm, respectively, for SLActive implants. The implant success rates were 96% for SLA and 100% for SLActive. Both SLA and SLActive implants therefore showed high success in irradiated patients.

Mineralized human bone allograft (MHBA) particles were used to augment narrow and wide sinuses in 23 patients with crestal bone ≤ 2 mm. Bone core biopsies were taken for assessment at implant placement and after 6 and 9 months. Newly formed bone was observed in all biopsies, with a woven structure after 6 months and a lamellar structure after 9 months. Bone formation after 9 months was 38.7 ± 7% in narrow sinuses and 30.7 ± 3% in wide sinuses; bone formation was significantly greater in narrow sinuses. MHBA appeared to promote satisfactory bone formation, and larger sinuses needed a longer maturation time for suitable new bone formation.

Two mandibular implants were placed in each of 20 edentulous patients and fitted with zirconia or titanium abutments. Bacterial sampling was performed and clinical parameters were evaluated after 2 weeks and 3 months. Similar amounts of A actinomycetemcomitans, P gingivalis, P intermedia, T forsythia, P micros, F nucleatum and T denticola were observed at both abutment types at both time points. Clinical conditions were healthy around both abutment types at both time points, with no significant differences in most clinical parameters except probing depth, which was greater around titanium abutments.

A total of 45 patients with 130 implants were allocated to be treated with direct (22 patients) or indirect (23 patients) ball attachment incorporation. All surgical and prosthetic interventions were recorded for up to 20 years. The mean follow-up time was 93 ± 57 months. All implants survived, but there was a significantly greater need for prosthetic intervention in the indirect attachment group. Significantly more visits were also required in this group for relief of pressure sores and liner exchange due to loss of retention. The direct attachment technique therefore appeared to be superior.

Implants were placed in the anterior maxilla of 20 patients with an all-ceramic crown on either gold, titanium or zirconia abutments. Peri-implant tissue colour and thickness were evaluated. Tissue colour appeared to be different from the contralateral tooth for all abutments, and the difference was significantly higher with titanium abutments compared with gold and zirconia. There was no correlation between degree of colour difference and peri-implant tissue thickness. Peri-implant tissue colour therefore appears to be different from that at the adjacent teeth, and this difference is more pronounced with titanium implants.

A total of 204 implants (176 in healed ridges and 28 in fresh extraction sockets) were placed in 75 patients. Implant survival rates were 98.6% in healed ridges and 96.4% in extraction sockets. Mesial and distal bone loss up to 12 months was 0.96 mm and 0.83 mm, respectively, and the mesial and distal bone changes from 24 to 36 months were 0.16 mm and 0.19 mm, respectively. The clinical parameters appeared to be comparable to those in other studies.

Each of five patients received six implants, three on each side of the mandibular arch in the premolar/molar region. On one side, implants were loaded via an immediate functional loading protocol, while on the other side the implants were loaded via an immediate progressive loading protocol. Radiographic analysis was performed at 0, 4, 9 and 24 months. Crestal bone height and peri-implant bone density were significantly better in the progressive loading group. Gradual loading may therefore allow greater bone maturation and density.

Peri-implant crevicular samples were obtained and analysed and clinical parameters recorded for 18 implants with peri-implantitis in 12 patients and from 21 healthy implants in 16 patients. Crevicular fluid volume, clinical parameters and duration of implant loading were all significantly greater in the peri-implantitis patients. C-telopeptide pyridinoline crosslinks of type I collagen was also significantly increased in the peri-implantitis group, but sRANKL and osteoprotegerin were significantly greater in the healthy patients. The results suggested an increased risk of bone loss around implants with peri-implantitis.

A literature search was conducted for studies with implant neck modifications and marginal bone loss over at least 5 years. From an initial list of 3,517 articles, 20 met the inclusion criteria and examined the use of microthreads (one study), implant surface modifications (11 studies), implant diameter (four studies), insertion depth (two studies), one-piece implants (three studies) and platform switching (one study). A statistical analysis was not possible due to the heterogeneity of the studies. The results did not indicate effectiveness for any specific implant neck modification in the preservation of prevention of marginal bone loss.

Literature on complication rates with fixed dental prostheses over at least 5 years was searched for. The initial search included 8,216 articles, of which 19 were selected for inclusion in the review. Direct comparisons of the incidence of complications in metal-ceramic versus metal-acrylic resin prostheses in edentulous patients were not found, and there were few studies on metal-ceramic prostheses, most of which were short-term. Various complications were found for metal-acrylic resin prostheses in long-term function, the most common being veneer fracture and material wear.

Each of 52 patients with an edentulous mandible received two implants to retain a mandibular overdenture; one implant was fluoride-treated and the other was not. Resonance frequency analysis (RFA) was performed at implant placement and radiographs were taken preoperatively, at overdenture connection and after 6 months and 1, 2 and 3 years. All implants survived, and no significant difference in marginal bone loss between the fluoride-treated and non-fluoride-treated implants was observed, and no relationship between RFA value and marginal bone level was observed. Fluoride treatment therefore did not help to prevent marginal bone loss.

Autogenous block grafting was performed in the anterior region of 15 patients, who were followed up yearly for a mean of 40 months. Peri-implant bone volume maintenance was analysed. In addition, clinical parameters were assessed at prosthesis delivery and follow-up. The initial buccolingual width was augmented 2.2-fold, 97% of which was maintained for 3.3 years. The difference in buccolingual width pre-and post-augmentation was significant. The implants displayed no mucosal recession or implant transparency after a mean of 40 months. Autogenous block graft in the anterior region was therefore a viable treatment option for alveolar ridge defects.

In two centres, a total of 51 patients with severely resorbed maxillae each received six implants, which were immediately loaded with a provisional restoration, with definitive restorations placed after 20-24 weeks. Patients completed the Oral Health Impact Profile (OHIP)-49 questionnaire before treatment and on three subsequent occasions. OHIP-49 scores increased in both centres over time. No significant differences in overall scores or individual domains between the centres were found. Significant increases were observed in all seven domains, with the lowest increases in social disability and handicap. The most important domains for patient satisfaction were functional limitation, physical pain, psychologic discomfort, physical disability and psychologic disability.

A total of 147 patients with 314 implants supporting mandibular overdentures were evaluated for 10 to 24 years. Implant survival and crestal bone level were assessed. A total of 101 patients were available for evaluation. There were 13 implant failures, giving a cumulative survival rate of 85.9% after 24 years. Two implants were removed due to peri-implantitis and 11 were removed due to mobility. For a mean observation time of 16.5 years, the mean crestal bone loss was 0.54 ± 0.7 mm; bone loss was significantly affected by duration of loading. A typical failure pattern was not elucidated, but more implants without signs of infection were lost than implants with peri-implantitis.

A total of 81 patients received 239 implants, which were immediately loaded; 101 were placed in healed sites and 138 in extraction sockets. The mean follow-up time was 6.7 years and the implant success rate was 96.6% (95.7% in extraction sites and 98.0% in healed sites); eight implants failed (six in extraction sockets and two in healed sites). Immediate loading in post-extraction sites was therefore comparable to that in healed sites.

A total of 39 four-walled extraction sockets in 25 patients were filled with Bio-Oss collagen (20 sockets) or left unfilled (19 sockets). Mean new bone formation was significantly lower at the Bio-Oss Collagen sites (25% mean new bone) than the ungrafted sites (44% mean new bone). The difference in bone formation was also significant between the apical and coronal parts of the socket, regardless of healing mode.

Lateral ridge augmentation of knife-edge ridges was performed using particulate autogenous bone, with or without bovine-derived bone mineral, in 25 ridges in 22 patients. A total of 58 implants were subsequently placed. The mean lateral augmentation achieved was 5.56 ± 1.45 mm after a mean of 8.12 ± 2.32 months. Implant survival was 100% for a mean follow-up time of 45.88 ± 12.43 months. New bone formation and good incorporation of the bovine bone mineral particles was observed.

A total of 20 completely edentulous patients received either three implants to support fixed dentures or two implants to support overdentures. Ball attachments were inserted after 8 weeks; overdentures were placed at 8 weeks and fixed dentures were placed at 16 weeks. Radiographs and patient satisfaction were assessed after 6 and 12 months. Quality of life and patient satisfaction were improved in both groups. All implants were in place after 12 months, and prosthetic complications were rare and manageable. Mandibular fixed prostheses can be placed on three implants, but a longer follow-up time is necessary for validation.

Tooth extraction and immediate implant placement with subepithelial connective tissue grafting was performed in 10 patients. Clinical and radiographic evaluation was performed before surgery, after implant placement and after 3, 6 and 12 months. No implants failed after 1 year, and the mean marginal bone and facial gingival level changes were +0.10 mm and -0.05 mm, respectively. After 1 year, over 50% papilla fill was observed at 80% of sites. The facial gingival level can therefore be maintained following connective tissue grafting.
International Journal of Periodontics and Restorative Dentistry
Vol. 31 No. 2 (March/April 2011)

The technique used for gingival recession coverage in this case series involved root coverage with a combination epithelialized-subepithelial connective tissue graft, since the recession may not be completely covered with a standard connective tissue graft. The epithelialized part of the graft was placed directly over the exposed roots. The results showed no displacement of the mucogingival junction or flattening of the vestibule.

A total of 16 patients who had lost the facial bony lamella received 18 implants, simultaneously with subperiosteal bone augmentation, and immediate provisionalisation. All implants were stable and implant survival after 13-36 months follow-up was 100%. Interproximal marginal bone stabilized at 1.0 to 1.3 mm above the first implant thread. Restoration of the facial lamella was confirmed, and soft tissue aesthetics were preserved, but oral hygiene status was a negative prognostic factor for the aesthetic outcome.
Journal of Clinical Periodontology
Vol. 38 No. 5 (May 2011)
Vol. 38 No. 6 (June 2011)

A case-control study was performed in patients with chronic periodontitis; 33 received only oral hygiene instructions, while 35 also received scaling and root planing. Salivary biomarkers were measured at weeks 0, 16 and 28. A significant improvement in periodontal health was observed in both groups, with a greater improvement in the scaling/root planing group after 16 and 28 weeks. Osteoprotegerin and TNF-α changed significantly in both groups, but IL-1β and MMP-8 decreased significantly only in the scaling/root planing group. Significant reductions in osteoprotegerin, MMP-8 and MIP-1α were observed in responders versus non-responders. Salivary biomarkers therefore reflected disease severity and response to therapy.

Data on periodontal diseases, chief complaints and compliance with periodontal therapy were obtained from 1,196 patients. Complaints were symptomatic in 36.9%, acutely symptomatic in 22.4% and asymptomatic in 40.7%. Patients with acute complaints were 60% more likely to receive periodontal treatment than symptomatic subjects; however, patients with acute complaints were also 60% less likely to complete treatment. Chief complaints were therefore associated with compliance with periodontal therapy.
Ng MC-H, Ong MM-N, Lim LP, Koh CG, Chan YH. Tooth loss in compliant and non-compliant periodontally treated patients: 7 years after active periodontal therapy. J Clin Periodontol 2011;38(5):499-508.
Data were retrospectively obtained from 273 compliant patients and cross-sectionally from 39 non-compliant patients for at least 7 years following active periodontal therapy for comparison. The rate of tooth loss in the compliant patients was 1.3 teeth/patient during therapy and 0.9 teeth/year thereafter, and the rate due to periodontitis was 0.03 teeth/patient/year. For non-compliant patients, the rate of tooth loss was 1.1 teeth/patient during therapy and 2.7 teeth/patient thereafter, and the rate due to periodontitis was 0.22 teeth/patient/year, a 7-fold increase compared to the compliant patients. No significant predictors of tooth loss were identified.

The costs of supportive periodontal care (SPC) and of replacing teeth were estimated, together with estimates of the effectiveness of SPC in preventing the loss of attachment or teeth. Outcomes with SPC were greater in specialist periodontal practices, but costs were higher than in public or private systems; however, SPC was also more cost-effective in specialist practices. SPC was cost-effective in private dental practices in the UK, Spain and Australia for modest attachment loss, whereas a higher valuation on avoiding attachment loss was needed to justify SPC in private or specialist practices in Ireland, Germany, Japan and the US.

A total of 93 patients enrolled from a smoking cessation clinic received non-surgical periodontal treatment concurrent with smoking cessation treatment. A structured questionnaire was administered, and periodontal examination was performed at baseline and after 3, 6 and 12 months. After 1 year, 52 patients remained in the study, of whom 17 ceased smoking and 35 continued or oscillated. Significant gain in clinical attachment level was observed in those who ceased smoking, but there were no significant differences between the groups for periodontal parameters after 1 year.

Coronally advanced flap (CAF) was performed in 41 patients with a total of 155 Miller class I or II recession defects; 20 patients were assigned to the control group and 21 were assigned to the test group, where orthodontic buttons were used to stabilise the flaps. Measurements were taken at baseline and after 7 days and 6 months. Complete root coverage was observed for 84% and 61% of the test and control group, respectively. Aesthetic satisfaction was also high in the test group compared to the control group. CAF plus orthodontic button was therefore an effective treatment for multiple gingival recessions.

Implants were placed in 10 patients with severe periodontitis 6 months after tooth extraction, and abutments were placed after a further 3-6 months. Plaque samples were extracted and analysed up to 1 year following abutment connection. Colony-forming units of aerobic and anaerobic bacteria were reduced and the salivary concentration of P gingivalis and T forsythia decreased. No changes were observed for A actinomycetemcomitans and negligible changes were seen for P intermedia. Pristine subgingival niches were rapidly colonised by key pathogens.

A total of 32 patients with 56 implants received bone substitute alone (15 patients, 27 implants) or with a resorbable membrane (17 patients, 29 implants). Systemic antibiotics and chlorhexidine rinsing were subsequently administered for 10 days. No significant differences in bone fill were found between the groups after 1 and 3 years. Plaque index decreased from approximately 40% to approximately 10% after 1 year and remained stable during the following 2 years. Defect fill could therefore be maintained in both groups.
Journal of Oral Implantology
Vol. 37 No. SP1 (March 2011) [Special Issue – Future of Implant Dentistry]
Vol. 37 No. 2 (April 2011)

Hahn JA. Four-year treatment and radiographic outcomes of 1-piece implants used in immediate function: a prospective study in a single private practice. J Oral Implantol 2011;37(2):259-265.

In 30 patients in a single practice, a total of 47 1-piece implants were placed and immediately loaded, and evaluated for up to 4 years. The cumulative survival rate was 97.9% and marginal bone levels were found to be stable over 4 years.

Bone grafting and implants were used to treat 17 patients with anterior maxillary defects; an apically repositioned split thickness connective tissue flap design was used, either at the time of bone grafting (nine patients) or at the time of implant uncovering (eight patients). No flap necrosis or dehiscence with graft exposure occurred, and keratinized tissue increased in all patients. The flap design was therefore a suitable technique, and could be performed at the same time as the graft procedure.

Each of 25 patients with an edentulous mandible received two implants and either ball or self-aligning attachments to retain overdentures. Patients were switched to the second attachment type after 3 months. The Oral Health Implant Profile (OHIP)-14 assessment was used to evaluate quality of life. OHIP scores in the physical disability domain were significantly better for the self-aligning attachment, and in a subgroup of, patients with below-average attachment space, OHIP scores for functional limitation, psychological discomfort, physical disability, psychological disability and total score were significantly better for the self-aligning attachment.
Journal of Periodontology
Vol. 82 No. 4 (April 2011)
Vol. 82 No. 5 (May 2011)

Intrabony defects in 30 patients were treated using a minimally invasive surgical technique (MIST) alone or in combination with enamel matrix derivative (EMD) and evaluated after 3 and 6 months using clinical, radiographic and gingival crevicular fluid marker assessments. Significant reductions in probing depth, gains in clinical attachment level, and stability of the gingival margin were observed in both groups. No significant differences were observed between the groups.

A total of 4,246 subjects in the Fourth Korean National Health and Examination Survey (KNHANES) underwent periodontal and anthropometric examination and completed a questionnaire. Body mass index (BMI) and waist circumference measurements were also taken. No association was found between BMI and periodontitis, but a significant association was found between abdominal obesity and periodontitis. The adjusted odds ratio for periodontitis in obese subjects was 1.358 (CI 1.003 to 1.839).

This study included and evaluated 112 patients with secondary amyloidosis (59 patients with familial Mediterranean fever (FMF), 40 with chronic infection or malignant disease and 13 with periodontitis) and 22 healthy subjects as controls. Periodontal health and disease were assessed and the concentrations of serum acute phase reactants measured 4 and 6 weeks following non-surgical periodontal therapy. In patients with FMF, the prevalence of moderate to severe periodontitis was 74.5% compared to 72.5% in patients with chronic infection or malignant disease and 84.6% in patients with periodontitis. A significant reduction in serum acute phase reactants was observed in amyloidosis patients following non-surgical periodontal therapy. The prevention or treatment of periodontitis may therefore help to alleviate the progression of amyloidosis.

A total of 199 patients with early signs of periodontitis or who were periodontally healthy were clinically monitored at 6-month intervals; gingival crevicular fluid and blood samples were also collected at each visit to assess IL-1β content and IL-1 genotype. A correlation was observed between increasing IL-1β levels and severity of disease, but no association was found between IL-1 genotype and disease or extent of disease. IL-1 genotype therefore did not appear to be a risk indicator for early periodontitis.

Scaling and root planing was performed in 56 periodontal sites in 28 patients and enamel matrix derivative (EMD) gel (test) or the PGA vehicle (control) were applied to the root surfaces for 3 mins. Gingival biopsies were collected for analysis after 48 h. there was a significant difference in microvessel density and VEGF expression between test and control sites, indicating that EMD induces proliferation, viability and angiogenesis of human microvascular cells. High correlations were shown at test sites among clinical attachment level, endothelial VEGF and microvessel density, but no such correlations were found at control sites.

A literature search was performed for articles on the effect of PRP on sinus graft. From a total of 61 articles searched, eight articles, detailing 352 bone grafts in 191 patients, were selected for inclusion. In four studies, no significant difference in implant survival was found between the two groups assessed. In five studies in the random-effects model, bone formation was found to be significantly greater in the intervention group; however, in two studies in the random-effects model, no significant differences in BIC were found between the two groups. Evidence therefore supports the use of PRP for bone formation, but there was no evidence for an effect on implant survival or BIC.

In this study, infrabony defects were treated with various regenerative techniques, including bioabsorbable membrane and autogenous bone (five defects), bioabsorbable membranes with deproteinized bovine bone (47 defects), non-resorbable membranes (seven defects), enamel matrix derivative (EMD; 41 defects) or a combination (20 defects). The mean follow-up time was 9 years. The tooth survival rate after 13 years was 90% and the gain in clinical attachment level was maintained for 11 years in 82% of defects. Long-term outcomes were influenced by smoking and oral hygiene maintenance. A high percentage of long-term success was therefore achieved.

A total of 119 implants were placed in patients with generalized chronic or generalised aggressive periodontitis (17 patients each). Clinical examination was performed on a 3-month recall schedule and radiographs were taken at regular intervals. Cone-beam CT was used to evaluate the circumferential 3-dimensional bone levels and determine the thickness of the keratinised mucosa. Significant bone loss at the buccal aspect was observed in both groups, and mean bone loss was significantly greater in the patients with generalised aggressive periodontitis. Thickness of keratinised mucosa was lowest in the anterior mandible in both groups. A significant correlation was found between clinical parameters and bone loss in patients with generalised aggressive periodontitis.

In 15 patients, Miller class I gingival recession defects were treated with coronally positioned flap (CFP) alone (control) or with anorganic bone mineral/peptide P-15 (test). Gingival recession was significantly reduced in both groups after 6 months, with no significant difference between the groups. Mean coverage of the exposed root was 85.56 ± 21.69% and 90.00 ± 18.42% in the test and control groups, respectively. Gingival thickness was significantly greater in the test group, and the gain in clinical attachment level was significant in both groups, with no significant difference between the groups. A positive correlation between bone height at baseline and reduction in gingival recession was noted in the test group.

A total of 20 intrabony defects in 10 patients were treated using open flap debridement alone or with a composite alloplast bone graft. Clinical parameters were recorded at baseline and 6 months, and plaque and gingival indices were recorded at baseline and 3 and 6 months. All parameters were significantly improved in both groups, but clinical and radiographic outcomes were significantly better in the alloplast group, indicating that the alloplast provided better treatment outcomes than open flap debridement alone.

Removable dental prostheses on the residual dentition with two types of attachments were placed in 23 patients with shortened dental arches. After 5 years, 70% of the prostheses in bilateral shortened arches were clinically functional, compared to only 25% of those in unilateral shortened arches. Fracture of abutment teeth was the most common cause of failure in the bilateral arches, while wear of the precision attachment was the most common cause in unilateral arches. There was no mean reduction in pocket depth for the abutment teeth, but there was a significant improvement in oral hygiene status. Removable prostheses with bilateral retention may therefore be a suitable treatment for shortened arches, but unilateral prostheses cannot be recommended.